ABSTRACT
In this study we used data on a sample of children in the Chicago Public Schools in areas of concentrated poverty-related disadvantage to examine associations between school climate and low-income children's language/literacy and math skills during the transition to kindergarten. We also explored whether teacher-child closeness moderated these associations. Multilevel modeling analyses conducted using a sample of 242 children nested in 102 elementary schools revealed that low adult support in the school was significantly associated with children's poorer language/literacy and math skills in kindergarten. Teacher-child closeness predicted children's higher language/literacy and math scores and moderated the association between low adult support and children's academic skills. Among children who were high on closeness with their teacher, those in schools with high levels of adult support showed stronger language/literacy and math skills. There were no significant associations between adult support and the academic skills of children with medium or low levels of teacher-child closeness. Results shed light on the importance of adult support at both school and classroom levels in promoting low-income children's academic skills during the transition to kindergarten.
ABSTRACT
PURPOSE: To critically review the efficacy, recurrence rate, and complications of needle aponeurotomy (NA) for the treatment of Dupuytren contracture. METHODS: This was a retrospective study of the results of NA for the treatment of Dupuytren contracture. We included in the study all patients who had NA performed for metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contracture of 20° or greater between March 2005 and May 2008. There were 474 patients with 1,013 fingers treated. The average age was 62 years (range, 33-92 y). Pre-procedure MP joint contracture averaged 35° (range, 15° to 95°), and PIP joint 50° (range, 15° to 110°). Immediately postprocedure and at least 3 years after treatment (range, 3.0-6.2 y), we measured MP and PIP joint contractures and reviewed records for complications. RESULTS: MP joint contractures were corrected an average of 99% and PIP contractures an average of 89% immediately postprocedure. At final follow-up, 72% of the correction was maintained for MP joints and 31% for PIP joints. The difference between the final corrections for MP versus PIP joints was statistically significant. When we compared the final results of patients age 55 years and older versus under 55 years, we found a statistically significant difference at both MP and PIP joints, with greater correction maintained in the older group. Gender differences were not statistically significant. Needle aponeurotomy provided successful correction to 5° or less contracture immediately postprocedure in 98% (791) of MP joints and 67% (350) of PIP joints. There was recurrence of 20° or less over the original postprocedure corrected level in 80% (646) of MP joints and 35% (183) of PIP joints. Complications were rare except for skin tears, which occurred in 3.4% (34) of digits. CONCLUSIONS: This study shows that NA is a safe procedure that can be performed in an outpatient setting. The complication rate was low, but recurrences were frequent in younger patients and for PIP contractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
